Common SSDI and SSI Myths
Occasionally, when people apply for Social Security Disability benefits or Supplemental Security Income, they are surprised to learn that some of the “facts” they’ve heard about these programs are incorrect. There’s a lot of inaccurate information floating around, so we’ve prepared a list of the most common misconceptions our clients have heard, along with clarifications.
If you have questions about your SSD case, call the law office of John R. Colvin to request a free consultation: 1-931-962-1044.
MYTH: SSDI payments will replace all of a claimant’s lost income.
FACT: The SSA bases benefits on the average taxable earnings for an applicant’s years of employment, called the Primary Insurance Amount. In cases where an applicant has earned low wages for at least 11 years, the SSA may offer benefit payments higher than the PIA. If the applicant receives other benefits, SSD payments may be lower than the PIA.
MYTH: Once the SSA approves a person’s claim for benefits, the beneficiary is entitled to lifetime benefits.
FACT: The SSA conducts what is called a periodic review of medical evidence to determine if a recipient’s disability continues. When benefit recipients report to the Administration that their disability has ended, or when the SSA makes that determination based on its periodic review of medical evidence, benefits end in the second month after the month the disability ended. Even if a recipient remains disabled, disability benefits automatically end in the month before an applicant’s 65th birthday (which is the age at which people can begin collecting full Social Security retirement benefits).
MYTH: The SSA will automatically award disability benefits to any Veteran that has been determined to be 100% disabled pursuant to a VA rating of disability.
FACT: The VA rating decision of disability is not controlling for the purpose of meeting the disability requirements of the Social Security Act. The SSA takes the position that a VA rating determination is not binding on the SSA.
MYTH: If awarded SSD benefits, the claimant will automatically receive back-pay, from the date of their disability onward.
FACT: Back-pay cannot exceed beyond one year prior to the initial application upon which benefits are awarded. There is also a mandatory five-month waiting period for SSD benefits from the date of onset, so applicants cannot receive benefits until the sixth full month following the onset date of their disability as long as this date does not exceed 12 months prior to the initial application. (Different rules apply in SSI Title XVI cases, i.e. generally there is no waiting period for SSI, but benefits cannot be paid before the beginning of the first month after the month in which the claim was filed).
MYTH: There is no age limit for filing and proving a Title II disability claim.
FACT: Applicants past full retirement age (FRA currently age 65) can still file for SSDI, but the period of disability must have begun at least five full calendar months before the month FRA is attained. An established period of disability for SSDI purposes has to be retroactive for anyone who has reached FRA.
MYTH: SSI (Title XVI) and SSDI (Title II) are interchangeable – a person who qualifies for one of those benefits automatically qualifies for the other.
FACT: SSDI (Title II) benefits require the applicant to have a qualifying work history or to be the dependent child, spouse, or widow/widower of a qualifying individual. SSI (Title XVI) benefits are based on financial need (resource rules) and may be awarded for a qualifying disability or to people age 65 and older that have no disability but meet the financial means test.
MYTH: The SSA considers only the applicant’s income in determining SSI financial eligibility.
FACT: The SSA uses a process called “deeming,” in which it reviews the income and resources of anyone responsible for the applicant’s welfare. The SSA may look at financial information for a parent, guardian, spouse, or other “essential person.” An essential person’s assets may make the applicant ineligible for SSI, even when the applicant receives no monetary support from that person.
MYTH: A treating doctor’s statement is adequate proof of a claimant’s disability.
FACT: The disability determination process requires extensive evidence that a claimant has a disability that has lasted, or is expected to last, for at least 12 consecutive months. The SSA in their policy rulings state that the adjudicator must find that the treating doctor’s statement is “well supported” by “medically acceptable” clinical and laboratory diagnostic techniques. Simply, the SSA cannot decide a case in reliance on a medical opinion/statement without some reasonable support for the opinion/statement. The treating doctor’s statement also must be “not inconsistent” with the other “substantial evidence” in the case record. In addition to medical proof, SSD and SSI applicants older than 18 must also satisfy a vocational determination that their disability prevents them from performing any type of work, not just their previous jobs. SSI applications for people under age 18 must include proof that their disability severely limits their functioning.
MYTH: There is a short-term federal disability program that provides assistance for claimants until they can draw their full disability benefits.
FACT: There is no “bridge” program that awards benefits during the waiting period or determination process. However, in SSI cases where evidence strongly supports a claim of blindness or disability, the SSA may award up to six months of payments during the determination process. Those payments do not affect one’s benefits, and even if the SSA determines the applicant does not have a qualifying disability, the applicant need not repay the temporary support payments.
MYTH: The date a claimant is entitled to Medicare is the same date that they are first entitled to collect SSD payments.
FACT: An SSDI recipient cannot get Medicare until after they have been entitled to regular SSDI benefits for at least two years. Therefore, claimants who have received at least 24 months of SSDI benefits will begin receiving their Medicare. However, it should be noted that the SSA makes limited exceptions to this rule and does not require a recipient to meet the 24-month entitlement rule in certain cases involving dialysis and hospice care.
Separating Fact from Fiction
The process of applying for disability benefits is complicated, and misinformation about rights and responsibilities has confused many applicants over the years.
For two decades, John R. Colvin has helped SSD applicants separate fact from fiction. If you need help with your case, ask for your free consultation today – just fill out our online form, or call us at 1-931-962-1044.
See above-time limit for filing and proving SSD Title II Claim which addresses age.